Category Archives: Health Care

Medicare for All? Medicare for Us Is Different

Power (And Free Stuff) For the People!

Blame this one on four wasted evenings watching the Democratic presidential debates.  As Senators Bernie Sanders and Elizabeth Warren and the rest were describing their promise of “Medicare for All,” my wife and I were deep in the process of learning about and registering for “Medicare for Us,” which kicked in this month.

The big discrepancies between the two inspired my column (here) in today’s Richmond Times-Dispatch.

The debate over health care policy and payment systems is a perfectly valid one for national politics.  Everyone sees the problems.  Like it or not the country is about half-way, perhaps more than half-way, to a fully federalized health care system.  Medicare, Medicaid and the military-related programs covered about 33 percent of Virginians in 2018, and federal regulations including but not limited to the Affordable Care Act dictate many policies for the rest of that sector.   Both political parties have added to the structure.  Continue reading

Health Insurance Check-Up; Migration to Medicaid

Number of carriers selling individual health insurance policies for next year by locality. Most places have only one or two. Source: SCC. Click for larger view.

The number of Virginians buying health insurance as individuals is shrinking and may shrink more, with two trends getting most of the credit:  Expansion of Medicaid eligibility and a change in the law that allowed those in business as sole proprietors to buy policies in the small group marketplace.

Individual coverage peaked at 418,000 Virginians in 2016 and dropped to 300,000 by March of this year.  The projection for 2020 is about 303,000 covered that way, the State Corporation Commission was told in a presentation on the health insurance market released July 18.  You can see the full presentation here. Continue reading

Magnifying Partisan Research with a Partisan Spin

Photo credit: Washington Post

Social scientific studies are increasingly infected by ideological bias and a crisis of unreplicable results. Compound that with the ideological bias of the mass media, which spin findings to advance their own partisan narratives, and you get articles like this one from the Washington Post: “Trump’s presidency may be making Latinos sick.

Trump’s presidency may be making some people sick, a growing number of studies suggest. Researchers have begun to identify correlations between Trump’s election and worsening cardiovascular health, sleep problems, anxiety and stress, especially among Latinos in the United States. A study published Friday using data from the Centers for Disease Control and Prevention found the risk of premature birth was higher than expected among Latina women following Trump’s election.

This is the same kind of junk reporting of tendentious science that we see increasingly in Virginia, where newspapers report on “studies” showing “correlations” that supposedly demonstrate the existence of systemic institutional racism. It’s not impossible that some of the studies are valid. But they need to be subjected to much closer scrutiny before being accepted and propagated widely, as they invariably are. Continue reading

Racial Disparities in Maternal Deaths: Another SJW Fraud

Dr. Jennifer Lee, director of the Virginia Department of Medical Assistance Services.

Virginia’s Medicaid program is targeting an alleged racial disparity in maternal deaths. African-American mothers have “consistently” died at more than twice the rate of white mothers during and after pregnancy, and they are more likely to die of natural causes, the Richmond Times-Dispatch informs us. (Black women are three times more likely to suffer a pregnancy-related death, according to The Virginia Mercury.)

“Maternal and infant deaths remain a troubling reality in our commonwealth and our nation,” said Dr. Jennifer Lee, director of the Department of Medical Assistance Services. “There remain stark racial disparities for African American mothers and their babies rooted in generations of racism and historical barriers to quality health care for people of color.”

This is the kind of rhetoric fostered by Governor Ralph Northam as he seeks atonement for dressing in blackface as Michael Jackson 35 years ago. “We have really tried to refocus our administration on a lot of inequities that exist in our society today,” he said yesterday. “One of the inequities that I really believe is quite glaring is the inequities of mothers of color and the mortality rate that not only they face but also that their children face. … This is unacceptable.”

So, how, precisely, will the Northam administration address inequities stemming from generations of racism? Aside from administrative changes designed to generate better data and enroll more women into the program, news accounts allude to two health-related initiatives: curbing tobacco use and connecting pregnant women with substance abuse treatment. If you are having trouble connecting the dots between “historical barriers to quality health care” and the decision of pregnant women to smoke, drink and take drugs, you’re not alone.

The data supporting the “generations of racism” argument are shockingly thin. Continue reading

Unpaid Bills, Debt Collection, and Hospital Profits

Carlos Ortiz. Photo credit: Wall Street Journal

Carlos Ortiz underwent tests last year at Mary Washington Hospital in Fredericksburg for dizziness stemming from an inner-ear problem. When the 65-year-old uninsured gardener couldn’t pay his $15,000 bill, the nonprofit institution took him to court. Mary Washington was suing so many patients that day that the circuit court had cleared the docket to hear all the cases.

As it turns out nonprofit hospitals are more likely than for-profit hospitals to garnish patients’ wages to collect their bills, according to a study of Virginia hospitals published Tuesday in the Journal of the American Medical Association and reported upon by the Wall Street Journal. In 2017 Virginia nonprofits filed 20,000 lawsuits against patients for unpaid debt.

Remarkably, the study found, nonprofits are more likely than for-profits to file lawsuits against patients for unpaid debt. These numbers do raise fundamental questions about Virginia’s social compact with its nonprofit hospitals. But hasty judgments are not in order. Continue reading

The Health Care Crisis: We Have Met the Enemy, and It is Us

Image source: The Atlantic

Thought experiment: What if you had the same health care system as Sweden…. but populated it with Americans? Would you have the same health outcomes as Sweden? Would health care as a percentage of the economy cost the same?

Writing in The Atlantic, David H. Freedman argues that high costs and poor medical outcomes are driven not only by the structure of the health care system but the expectations and behaviors of Americans.

We ought to consider the possibility that if we exported Americans to … other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?

Continue reading

Oops, We Did It Again

What a shock! Virginia’s Medicaid expansion isn’t working out as planned. Today we learn that Virginia’s private hospitals, which are paying a tax to defray the state’s 10% share of expansion (Uncle Sam pays the rest), is on track to receive only 78% of the Medicaid revenue they expected, reports the Richmond Times-Dispatch.

The big question is whether the shortfall is a one-time event caused by a slower-than-expected rollout of the program or a permanent feature of the healthcare landscape.

Department of Medicaid Assistance Services (DMAS) estimated that the influx of 300,000 to 400,000 Medicaid patients would increase hospital industry revenues by $247 million in the second half of the 2019 fiscal year. So far, the actual net increase is on pace for $192 million for the six-month period. The hospital lobby agreed to the tax in the expectation that a surge in Medicaid revenue would more than offset it.

“We’re rolling out a little bit more slowly than anticipated,” said Chris Gordon, chief financial officer for DMAS. “We’re continuing to monitor and adjust our forecast. We continue to learn from experience.”
Continue reading

Long-Term Care: A Great Bet If Made Long Ago

It is just like your econ professor told you – insurance is nothing but a bet.  It is a bet you often don’t want to win, but in one field you had a great chance of winning simply by hanging around and continuing to breathe.  That field is (or at least was) long-term care coverage.

Two top executives from major insurers told the State Corporation Commission last week just how badly their companies calculated the risk on long-term care decades ago.  They were seeking to explain the major premium increases their companies are seeking here in Virginia and all around the country in a proceeding previewed (here) in March on Bacon’s RebellionContinue reading

Are PBMs Killing Pharmacies, Hiking Medicaid?

Stoney Creek Pharmacy, Nellysford, VA

A form letter mailed this month announced the death of another local independent pharmacy, this one in the bustling community of Nellysford.  Residents of Nelson County’s Rockfish Valley, including those in the large Wintergreen community, will join plenty of other rural areas in the U.S. without a pharmacy close by.  Continue reading

Bacon Bits: A Little Bit of This, a Little Bit of That

Safe hospitals. I’ve long maintained that the best thing you can do for your health is stay out of hospitals — 160,000 deaths occur annually across the country from avoidable medical errors monitored by the Leapfrog Hospital Safety Grade. Fortunately, Virginia hospitals are safer than most. The Old Dominion has the second highest percentage — 53% — of hospitals in the country of hospitals meriting Leapfrog’s A rating. In Maryland only 25% of hospital scored an A, and in Washington, D.C., there are no A-rated hospitals, reports the Richmond Times-Dispatch.

Expanding hospital. Speaking of  hospitals, Carilion Roanoke Memorial Hospital has just announced a $300 million expansion that includes a new tower to care for emergency and heart patients, a new behavioral health hospital across the street, a parking garage and a pedestrian skyway to connect it all. The expansion is part of Carilion’s plan to invest $1 billion over the next seven years, according to the Roanoke Times. Roanoke Memorial scored a B in Leapfrog’s ranking, incidentally. Roanokers might legitimately inquire if some of that $300 million could be better spent on preventing avoidable medical errors.

Bye, bye, Jeff, baby. The Commonwealth Transportation Board unanimously voted yesterday to allow Arlington County to change the name of Route 1 from Jefferson Davis Highway to Richmond Highway, reports the Washington Post. The United Daughters of the Confederacy had spearheaded the naming of the highway after the president of the Confederate States of America, as a “direct and antagonistic response” to the establishment of Lincoln Highway across the northern states, said Arlington Board Chair Christian Dorsey. Continue reading

Bacon Bits: Alexa, Graphene, Nurse Practitioners

Hey, Alexa, does Amazon have any job openings for its Alexa project? Amazon has posted its first job listings for its new Arlington County headquarters and is moving two vice presidents from Seattle to Arlington, reports the Washington Post. One will oversee workforce development, and the other will run a technical team focused on international growth of its virtual assistant Alexa.

Commercializing one of the world’s most awesome materials. Graphene is 200 times stronger than steel. It is superb at conducting heat and electricity. And it’s incredibly pliable. Now the Carbon Research and Development Co. is building a Graphene Research Center in Wise County with the backing of a $1.5 million loan from the Virginia Coalfield Economic Development Authority. The Center, which is focusing on applications in the manufacturing center, is collaborating with Virginia Tech, reports the Roanoke Times, to derive the carbon-based material from coal.

First nurse practitioner licensed under new law. Continue reading

Bacon Bits: Rural Development Edition

Seeding entrepreneurship. The Virginia Coalfield Economic Development Authority has approved $180,000 in seed-capital grants up to $10,000 for businesses that have been operating less than a year and have fewer than 10 full-time employees. The new businesses are projected to create $770,000 in total private investment and create 135 full-time and part-time jobs. Assuming the businesses deliver on their investment and jobs — not to be taken for granted — this looks like a promising approach to economic development. Since it started two years ago, reports the Bristol Herald-Courier, 53 businesses receiving micro-grants have generated $3.1 million in private investment and created 542 full- and -part-time jobs. Beats subsidizing an out-of-state company to build a light manufacturing plant and then shut it down 10 years later.

Addressing the doc shortage. Southwest Virginia has a chronic shortage of doctors, nurses and other health care providers. The United Company Foundation in Bristol is issuing a $1 million challenge grant to the Edward Via College of Osteopathic Medicine in Blacksburg to lower medical school debt for doctors who agree to practice in Southwest Virginia, reports the Roanoke Times. Two $40,000 scholarships will be awarded this spring to third-year medical students. After they complete their residencies, they will be required to work for three years in the region.

To plug the broadband gaps, first you have to find the broadband gaps. Continue reading

Medicaid: Report The Taxes Along With The Growth

Expansion tracking on the Virginia DMAS website. Click to expand, web version is here.

Virginia makes is easy to track the growth of Medicaid enrollment since the decision a year ago to expand coverage but tracking the tax dollars behind the scenes is another matter.

The new enrollment expansion dashboard on the Department of Medical Assistance Services website is updated every couple of weeks, with the April 4 report showing just under 260,000 people added to the program since late last year.  The City of Salem has added the fewest, only 34 new recipients, while Fairfax County has added the most at 18,220.  The advertised goal for expansion was 400,000 persons, so probably there are more to come.  Continue reading

Addiction as a Workforce Development Issue

How ubiquitous is drug abuse in Virginia’s workforce? In western Virginia, it’s mind-numbingly pervasive.

“In many environments, as many as 50 percent of employee applicants who are eligible on the basis of their training, skills, and background fail to be employable because they fail to pass a drug screen,” Dr. Bob Trestman, chairman of psychiatry for Carilion Clinic, told Roanoke-area employers in a panel talk yesterday, reports the Roanoke Times.

Most employers have Employee Assistance Programs but Trestman said employees are reluctant to use them because addicts are stigmatized. “We need to think of them as people with an illness. Then we can reframe how we approach care and treatment and engage and support them in the workplace safely.” Continue reading

Virginia’s “Secret” Medical Marijuana Program

The doctor who should be governor. State Sen. Siobhan Dunnavant is a Republican from Henrico County. She is also a practicing physician. In this year’s General Assembly session she put forth SB1557 which expanded last year’s so-called “Let Doctor’s Decide” legislation (HB1251).

What’s new? The 2018 legislation (HB1251) authorized licensed medical providers to prescribe CBD and THC-A oil “to alleviate the symptoms of any diagnosed condition or disease determined by the practitioner to benefit from such use.” CBD, or cannabidiol, is a naturally occurring compound found in the resinous flower of marijuana plants. It is used to treat a variety of maladies. It is non-intoxicating. THCA, or tetrahydrocannabinolic acid, is the non-psychoactive acid form of THC found in marijuana plants when raw. It is also non-intoxicating unless it is heated. Once heated, THCA releases THC which is intoxicating.  The 2018 legislation restricted THCA oil to contain no more than 5 mg of THC (the psychoactive component of marijuana). Continue reading